| NPI | 1457410912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301087003) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301087003) |
| 2084P0005X Psychiatry & Neurology Neurodevelopmental Disabilities (Licence: MI 4301087003) | |
| 208D00000X General Practice (Licence: MI 4301087003) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2023-09-14 |